The Shingles vaccine debate - and PMR

[PMRpro]

I had totally forgotten that I found this bit of info well over a year ago when the usual question about the shingles vaccine was asked and wrote a post about it:

"I can't give you the direct link but on a site called "virginiahopkinstestkits" There is a quote from Merck ( the makers of Zostavax):

"According to Merck, the maker of Zostavax, “Serious vaccine-related adverse reactions that have occurred following vaccination with Zostavax include asthma exacerbation and polymyalgia rheumatica [An inflammatory disorder that causes widespread muscle aching and stiffness, primarily in your neck, shoulders, upper arms, thighs and hips, that can last months or even years.] Other serious adverse events reported following vaccination with Zostavax include cardiovascular events (congestive heart failure, pulmonary edema).”

The Zostavax vaccine can also cause shingles.

Notice the CDC says that the vaccine is effective for about half the population age 60 to 69, but only provides “some protection” for older groups. As we get older, it’s more difficult for our immune systems to mount an antibody response in response to a vaccine. That’s why the flu shot isn’t very effective for senior citizens."

You can get a link there for Merck's prescribing info. Google a chunk of the quote and you should get a direct link so you can use it.

If the manufacturers are admitting this it should be taken seriously."

This is the direct link to merckvaccines where you can read it yourself - straight from the horse's mouth:

merckvaccines.com/Products/...

[Retailmonkey]

Hi PMRpro

Am I reading this correctly that Merck have seen a correlation between the administering of the shingles vaccine and the development of PMR? Whilst they do mention side effect symptoms that may be seen in PMR in their Patient Information sheet, they do not mention PMR itself. It may be that more investigation is needed into the occurance of PMR post vaccination in which case rheumatology deparments should be collecting that information. Whilst PMR obviously pre-dates the introduction of the vaccine, if there is a link it may lead to more understanding of the base causes.

Given your comments about the effectiveness maybe there should be more indications about this as a side effect for people to understand the potential risk.

Seeing your post i have been trying to remember when I had the vaccine (which was definitely before I noticed PMR symptoms) in relation to when my PMR symptoms started - GCA symptoms came along sometime later and maybe support the theory of the development of PMR into GCA. If I had knownof the risk I would not have had the vaccine

[PMRpro Ambassador in reply to Retailmonkey]

That's how I read the final link yes - and it is on their site! PMR is also mentioned in the full prescribing information on the data sheet. During the clinical trials 2 subjects developed PMR after vaccination. There were also a similar number of cases in the placebo group - but they were all deemed confirmed investigator-determined vaccine-related events. So maybe it is something in the carrier rather than the pure vaccine itself.

Nevertheless, the thought of us being encouraged to have a vaccine that even the manufacturers admit was possibly associated with the development of polymyalgia rheumatica and can also trigger shingles does seem - to put it mildly - very strange!

[SnazzyD in reply to PMRpro]

I didn't have the brain this evening to look, but in some other vaccine trials I've looked at, a placebo isn't a true placebo as I see it, like saline. Instead it is the fluid with all the adjuvants etc in it, but not the organism. If it is the added fluid and constituents that cause the reaction, it wouldn't show up as statistically significant between the two groups.

[Celtic PMRGCAuk volunteer]

OMG! What an important 'find', PMRpro. Although I'm not likely to have the vaccine as I'm already known to be allergic to the Neomycin it contains, after reading that I would steer well away from it anyway. Invaluable information, although I do hope it doesn't raise too much stress in those who may already have been vaccinated. As a 'live' vaccine, hopefully most with PMR will have avoided it.

[PMRpro Ambassador in reply to Celtic]

Already had one response on patient,info from someone who had it - and his PMR appeared soon after. As he says "coincidence?"

I'm just so annoyed I had forgotten it - it was over a year ago I found it originally but it could be 2 or 3...

[HeronNS]

"That's why the flu shot isn't very effective for senior citizens." Comments please.

I still avoid the flu shot. Do you think at over 69 I might as well forget about it forever?

[PMRpro Ambassador in reply to HeronNS]

It is still somewhat effective - and every little helps when you have a dodgy immune system.

On the other hand - since you reject it anyway, why bother even considering it?

[HeronNS in reply to PMRpro]

Well, there is so much scare publicity about the flu I always feel I should give in and get it.

[PMRpro Ambassador in reply to HeronNS]

Having had proper flu once when I was still healthy and OH having had it a couple of years ago and developed pneumonia - never want it again! I barely made it out of bed for a week and it was several weeks before I felt better. OH was still "doctoring" 6 months later. He is extreme I suppose - but that is a contributory factor for me. Part of the reason for flu vaccines is herd immunity - it protects the people who are at risk better if a larger proportion of the community around them have been vaccinated. There are also a lot of them who cannot have the vaccine so those of us who can, should. In that sense I regard it as a public duty.

[HeronNS in reply to PMRpro]

That's why I had the shot the year of h1n1. I was guilted into protecting the vulnerable youth. I also came over all funny right afterwards and had to sit for a while, never had a reaction to vaccination like that before, and ended up with a huge multi-coloured bruise at injection site.

[SnazzyD in reply to PMRpro]

Or controversially, another theory is that it enables people to have subclincal infection and become silent carriers. Whatever, I don't think any of it is an exact science however black and white it is presented.

[Thomas45]

I've had shingles 3 times, despite people thinking you can only have them once. Nevertheless I was advised by the medics to have the jab and did, at the same time as the 'flu jab, but in the other arm. As well as PMR I've had asthma for 41 years, Paroxysmal Atrial Fibrillation fort nearly 21 years, PMR for 3 years 4 months, and lymphoedema diagnosed 1 month ago - had it for years but previously diagnosed as fluid retention. I'm down to 1.5mg of prednisolone daily, and soon will be down to 1mg. I think I probably don't have PMR any more. I sometimes get shoulder aches but mainly when I've been stood at the sink washing up, or doing similar manoeuvres. I think that comes from me being tall (6' 7") and not very fit. There have been days when I've forgotten to take pred, with no adverse consequences. I'm 71.

[PMRpro Ambassador in reply to Thomas45]

It's chicken pox people usually think you can only have once - and that isn't true either, it depends on how severe (or mild) the first case was and whether you developed immunity.

Shingles happens because the dormant virus reactivates - and since it doesn't go away but remains in the body that can happen several times. Not that I'd wish it on anyone once, never mind 3 times! Ouch!

[cdenoncourt]

Interesting. I can't find any mention of a time frame for the adverse reaction that occurred. I had the shingles vaccine in early 2010 and my PMR symptoms began in late 2011. I wonder if that's too much later to suspect a connection. In mid 2013 when methotrexate was tried along with the pred in hopes of being pred sparing, I came down with shingles within 3 weeks and had to stop the MTX. I'm not very impressed with the vaccine. I was told is was a mild case, but it was still very painful. For those who worry about getting shingles, I will say the anti-viral drug used to treat it gave rapid relief and healing.

[PMRpro Ambassador in reply to cdenoncourt]

They monitored for the adverse reactions for days 1 - 42 and then in follow-up. As I understood it, the cases of PMR occurred during the follow-up period which varied between 2 and 5 years depending on the patient rather than in the first 6 weeks. But they still attributed it to the vaccine.

I'm far from convinced by what I have read in the clinical trials and the assessments of the vaccines in official documents.

[judam9]

Dear @PMR Pro. thnak you for the info, on the shingles vaccine. i have heard that some people who had the vaccine, even had the shingles like 2 or 3 times after the vaccine. i'm glad that the price steered me away from it.

[TooSore]

An added note - my mother went to get the vaccine and discovered that since she is allergic to neomycin she cannot have it. ( in addition-Reading about the effectiveness as you get older makes me wonder why it was suggested to her as she was over 80 at the time.)

[PMRpro Ambassador in reply to TooSore]

Yes - forgot to mention that. Celtic has the same "problem". Wonder how many doctors know that? Come to that, how many people know they are allergic to neomycin?

[Evercurious]

Had the shingles vaccine weeks before PMR symptoms appeared. Had I only known of the possibilities I would never had had it!

[PMRinUSA]

This really worries me, because I had chicken pox as an adult and it was horrible -- I got it from my children, who had received the vaccine but got very mild break-through cases anyway with just a few spots. I of course as covered in spots and very sick. I am on the waiting list to get the shingles vaccine (limited supply) because my sister had shingles and it was terrible, and I thought I had better try to prevent it. But I don't want to cause a flare of my PMR! Any others who seem to have had this correlation? Or is the correlation only for initial onset of PMR? That is how I read the Merck page. Thoughts anyone?

[PMRpro Ambassador in reply to PMRinUSA]

Post this as a new thread - very few people will see it here on this one that is 3 years old!!!